Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, OH, USA.
J Crohns Colitis. 2022 Nov 23;16(11):1696-1705. doi: 10.1093/ecco-jcc/jjac078.
Postoperative recurrence [POR] of Crohn's disease following ileocolonic resection is common. The impact of immediate postoperative intra-abdominal septic complications [IASC] on endoscopic and surgical recurrence has not been elucidated.
To evaluate if IASC is associated with an increased risk for endoscopic and surgical POR.
This was a retrospective study of adult Crohn's disease patients undergoing ileocolonic resection with primary anastomosis between 2009 and 2020. IASC was defined as anastomotic leak or intra-abdominal abscess within 90 days of the date of surgery. Multivariable logistic and Cox proportional hazard modelling were performed to assess the impact of IASC on endoscopic POR [modified Rutgeerts' score ≥ i2b] at index postoperative ileocolonoscopy and long-term surgical recurrence.
In 535 Crohn's disease patients [median age 35 years, 22.1% active smokers, 35.7% one or more prior resection] had an ileocolonic resection with primary anastomosis. A minority of patients [N = 47; 8.8%] developed postoperative IASC. In total, 422 [78.9%] patients had one or more postoperative ileocolonoscopies, of whom 163 [38.6%] developed endoscopic POR. After adjusting for other risk factors for postoperative recurrence, postoperative IASC was associated with significantly greater odds (adjusted odds ratio [aOR]: 2.45 [1.23-4.97]; p = 0.01) and decreased time (adjusted hazards ratio [aHR]: 1.60 [1.04-2.45]; p = 0.03] to endoscopic POR. Furthermore, IASC was associated with increased risk (aOR: 2.3 [1.04-4.87] p = 0.03) and decreased survival-free time [aHR: 2.53 [1.31-4.87]; p = 0.006] for surgical recurrence.
IASC is associated with an increased risk for endoscopic and surgical POR of Crohn's disease. Preoperative optimization to prevent IASC, in addition to postoperative biological prophylaxis, may help reduce the risk for endoscopic and surgical POR.
克罗恩病术后复发[POR]是常见的。术后早期腹腔感染性并发症[IASC]对内镜和手术复发的影响尚未阐明。
评估 IASC 是否与内镜和手术 POR 风险增加相关。
这是一项回顾性研究，纳入 2009 年至 2020 年间行回肠结肠切除术并一期吻合的成年克罗恩病患者。IASC 定义为术后 90 天内吻合口漏或腹腔脓肿。多变量逻辑和 Cox 比例风险模型用于评估 IASC 对术后首次内镜检查时内镜 POR[改良 Rutgeerts 评分≥i2b]和长期手术复发的影响。
在 535 例克罗恩病患者[中位年龄 35 岁，22.1%为吸烟者，35.7%有一次或多次既往手术]中，有少数患者[N=47；8.8%]发生术后 IASC。共有 422 例[78.9%]患者接受了一次或多次术后内镜检查，其中 163 例[38.6%]发生了内镜 POR。在调整了其他术后复发的危险因素后，术后 IASC 与更高的可能性（调整后的优势比[aOR]：2.45[1.23-4.97]；p=0.01）和更早的时间（调整后的危险比[aHR]：1.60[1.04-2.45]；p=0.03）发生内镜 POR 相关。此外，IASC 与手术复发的风险增加（aOR：2.3[1.04-4.87]；p=0.03）和生存时间减少[aHR：2.53[1.31-4.87]；p=0.006]相关。
IASC 与克罗恩病的内镜和手术 POR 风险增加相关。术前优化以预防 IASC，除了术后生物预防，可能有助于降低内镜和手术 POR 的风险。
